How to start working in a Public Health Setting as a Dental Hygienist with a Collaborative Agreement More questions? Contact us at Public Health Dental Hygiene Toolkit

Direct Access through a collaborative agreement in Utah Have you ever wondered what direct access dental hygiene practice options are available to Utah Dental Hygienists? Want to find a professional challenge, open doors to new opportunities, provide the unique satisfaction while being able to provide services to people unable to obtain them? Then you may want to investigate practicing with a collaborative agreement as a new career option, as a part-time vocation, or even on an occasional or volunteer basis. With a collaborative agreement a dental hygienist establishes a written agreement with a Utah dentist who commits to be available for consultation in person, by phone or electronic communication as necessary. The dental hygienist and dentist jointly establish the agreement that describes how the practice will work and what information should be reported back to the dentist.collaborative agreement The dental hygienist may provide services within the scope of dental hygiene practice as provided by Utah law without a dentist present, except local anesthesia and nitrous oxide administration. Collaborative Agreement: Is it Right for You?

Requirements You must be a licensed dental hygienist in Utah No additional education is required Settings Public Health settings defined as an individual's residence, if the individual is unable to leave the residence school, as part of a program nursing home assisted living or long-term care facility community health center federally-qualified health center mobile dental health program that employs a Utah licensed dentist Services All general supervision preventive service allowed under our scope of practice Local Anesthesia and N2O are not allowed Currently Utah Medicaid does NOT allow direct reimbursement to a dental hygienist Requirements for a Public Health Dental Hygienist

Statutes & Rules State Dental Practice Act: 9/C58-69_ pdf 9/C58-69_ pdf Dental Board Rules: Licensing Board DOPL: Applicable Forms Collaborative Agreement: content/uploads/2016/07/UDA-Collaborative- Agreement.docx content/uploads/2016/07/UDA-Collaborative- Agreement.docx Agreement Practice Guidelines: content/uploads/2016/07/GUIDELINES.docx content/uploads/2016/07/GUIDELINES.docx Patient Consent Form: content/uploads/2016/07/Patient- Informed-consent.docx content/uploads/2016/07/Patient- Informed-consent.docx Additional Links CPR Certification Liability Insurance NPI application Practice as a Public Health Dental Hygienist– What Else Do I Need to Know?

Do you want to get paid for the dental hygiene services you provide? You may need to consider starting your own business where you can receive payments. This Small Business Administration link will help and here is one just for a Utah business.Small Business Administration Utah business If you are self-employed you will be responsible for paying your own social security and federal and state income taxes directly to the government. To learn more about income reporting requirements, visit: You will also be required to obtain a free employer identifier number (EIN) to use on tax and other business filings and to submit insurance claim forms. For more information visit IRS Employer ID Numbers (EINs)IRS Employer ID Numbers (EINs) A "DBA" (also known as Doing Business As) is a legal name you decide to give your business. You may want to name your business to present a more professional image, heighten the visibility of your business and accept checks using a business account. Business Considerations

Liability Insurance is Necessary! All dental hygienists working in public health setting should maintain their own personal liability insurance. The dental hygienist will not be covered by the collaborating dentists’ policy in alternative settings. You will want to choose a policy will cover you to the full extent in alternative settings. If you are self-employed you need individual protection for yourself and your business even more so. Professional liability insurance coverage is generally restricted to matters relating to patient care - it will not cover loss or damage to equipment, general negligence issues or other matters. ADHA offers great information on professional liability and other types of insurance for self-employed dental hygienists, as well as equipment replacement insurance at: Liability Insurance is Necessary! All dental hygienists working in public health setting should maintain their own personal liability insurance. The dental hygienist will not be covered by the collaborating dentists’ policy in alternative settings. You will want to choose a policy will cover you to the full extent in alternative settings. If you are self-employed you need individual protection for yourself and your business even more so. Professional liability insurance coverage is generally restricted to matters relating to patient care - it will not cover loss or damage to equipment, general negligence issues or other matters. ADHA offers great information on professional liability and other types of insurance for self-employed dental hygienists, as well as equipment replacement insurance at: Insurance & Liability

Utah does NOT currently allow Medicaid reimbursement. But stay informed to legislative changes. Many, but not all, private insurance companies will reimburse dental hygienists. Some of these will reimburse patients, but not pay the dental hygienist directly. Some might limit the codes they will reimburse to dental hygienists. It is prudent to discuss with the patient that reimbursement can be withheld, leaving them responsible for payment, or that they may need to submit for reimbursement themselves. Follow this link to order a manual of CDT dental codes.CDT dental codes Insurance Claim Form: ADA generic claim form for submitting insurance claims for your patients or have your patients do it. You can also download the claim form from the patient’s insurance company. You can submit claim forms online or through mail.ADA generic claim form In order to file an electronic claim to a third party payer, whether private insurance or Medicaid, you need your own National Provider Identifier (NPI). Utah does NOT currently allow Medicaid reimbursement. But stay informed to legislative changes. Many, but not all, private insurance companies will reimburse dental hygienists. Some of these will reimburse patients, but not pay the dental hygienist directly. Some might limit the codes they will reimburse to dental hygienists. It is prudent to discuss with the patient that reimbursement can be withheld, leaving them responsible for payment, or that they may need to submit for reimbursement themselves. Follow this link to order a manual of CDT dental codes.CDT dental codes Insurance Claim Form: ADA generic claim form for submitting insurance claims for your patients or have your patients do it. You can also download the claim form from the patient’s insurance company. You can submit claim forms online or through mail.ADA generic claim form In order to file an electronic claim to a third party payer, whether private insurance or Medicaid, you need your own National Provider Identifier (NPI). Payment: Reimbursement from Insurance Agencies

In order to file an electronic claim to a third party payer, whether private insurance or Medicaid, you need your own National Provider Identifier (NPI). An NPI is a 10 digit number, assigned for free by the federal government, that serves as a permanent identifier of you as a healthcare provider, even if you move or are relicensed in a different profession. Even if you do not anticipate billing third parties directly, it is probably a good idea to apply for the free NPI anyway because it may facilitate billing actually submitted by a health department or other entity for services that you provided. For more information about the NPI and how to obtain one, please visit the NPPES website or or contact NPPES directly by phone at (800) NPPES websitehttps://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart In order to file an electronic claim to a third party payer, whether private insurance or Medicaid, you need your own National Provider Identifier (NPI). An NPI is a 10 digit number, assigned for free by the federal government, that serves as a permanent identifier of you as a healthcare provider, even if you move or are relicensed in a different profession. Even if you do not anticipate billing third parties directly, it is probably a good idea to apply for the free NPI anyway because it may facilitate billing actually submitted by a health department or other entity for services that you provided. For more information about the NPI and how to obtain one, please visit the NPPES website or or contact NPPES directly by phone at (800) NPPES websitehttps://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart Payment: NPI

Typical fee schedule: D01110 Adult Cleaning $45-70D01204 Adult Fluoride $12 Screening $15-20 D04341 Quad Scale $ D04910 Perio Prophy $60-80 Radiographs $20-40 Patient Form Links: Patient Health History Patient Health History and HIPPA Dental Health HistoryHIPPA Dental Health History Patient Consent to Treatment Patient Consent to Treatment (includes notice that treatment by a dental hygienist is not a substitute for a dental examination by a dentist) Power of Attorney (if needed) It is best to obtain a copy of medical orders for any patient that you treat and discuss any conditions of medically compromised patients with the collaborating dentist. Dental Hygiene Treatment Record: Keep detailed records for you and your patients best care. Simple treatment record (PDF) or recommend keeping documentation on a computer. Referral Form: Referral to the Collaborating dentist or the patient’s personal dentist. Typical fee schedule: D01110 Adult Cleaning $45-70D01204 Adult Fluoride $12 Screening $15-20 D04341 Quad Scale $ D04910 Perio Prophy $60-80 Radiographs $20-40 Patient Form Links: Patient Health History Patient Health History and HIPPA Dental Health HistoryHIPPA Dental Health History Patient Consent to Treatment Patient Consent to Treatment (includes notice that treatment by a dental hygienist is not a substitute for a dental examination by a dentist) Power of Attorney (if needed) It is best to obtain a copy of medical orders for any patient that you treat and discuss any conditions of medically compromised patients with the collaborating dentist. Dental Hygiene Treatment Record: Keep detailed records for you and your patients best care. Simple treatment record (PDF) or recommend keeping documentation on a computer. Referral Form: Referral to the Collaborating dentist or the patient’s personal dentist. Practice Paperwork

DATA COLLECTING IS CRITICAL in order to show the positive impact of dental hygienists working in public health settings it is imperative that the dental hygienist keep track of the following: Population: Age of population served Insurance: What percentage of patient’s served have insurance or did they self pay, or where their fees covered by another source Regularity: When was the last time they visited a dentist? Home care: How often are they brushing, flossing, do dentures fit? Oral Care Information: Edentulous (dentures/no dentures), untreated decay, root fragments, gingivitis, tooth mobility, urgent needs, etc. Collect Your Data Here DATA COLLECTING IS CRITICAL in order to show the positive impact of dental hygienists working in public health settings it is imperative that the dental hygienist keep track of the following: Population: Age of population served Insurance: What percentage of patient’s served have insurance or did they self pay, or where their fees covered by another source Regularity: When was the last time they visited a dentist? Home care: How often are they brushing, flossing, do dentures fit? Oral Care Information: Edentulous (dentures/no dentures), untreated decay, root fragments, gingivitis, tooth mobility, urgent needs, etc. Collect Your Data Here Data Collecting

Additional Resources Utah Dental Hygienists Association The Working column in Access magazine highlights on dental hygienists who have pursued a variety of career paths: ADHA’s Standards for Clinical Dental Hygiene Practice: ADHA’s Public Health Listserv is a forum to exchange information about careers and practice in public health: UDHA of Facebook: ADHA on Facebook: ADHA on Linkedin: